The Case for Board Oversight of Quality and Patient Safety

Historically, quality oversight was delegated to the management or clinical staff and not considered to be the purview of healthcare boards. Directors did not consider this a significant aspect of their governance role. “We aren’t clinicians,” they would often say, and “our focus is the mission and advocacy.”

This, however, is changing in response to legal and regulatory requirements and increasing pressure from purchasers and payers to demonstrate improved quality of care. Health care organizations across the country are seeing a movement in which the board is playing a greater role in overseeing the quality and safety of care provided. This shift is being driven in large part because the environment in which non-profit boards operate has become increasingly challenging. Perceptions of the duties of the board have changed, and non-profit healthcare organizations are being scrutinized more closely than ever before. With a large number of federal and state agencies, the courts and other stakeholders’ increasing willingness to second-guess board decisions, directors need to have a clear understanding of their legal responsibilities particularly as they relate to quality and safety oversight.

Legal and Regulatory Imperatives

With pay-for-performance and greater consumer scrutiny of care, health care organizations are being asked to be even more publicly accountable for their patient’s care, especially if something goes wrong. Case law examples, changes in state statutes and accreditation standards by accrediting bodies throughout the sector have placed quality and client safety clearly in the board’s area of responsibility. Boards who have historically entrusted the oversight of quality and safety to the organization’s executives and clinicians now find that they must also demonstrate accountability for and knowledge about the safety and quality of client care.

Moral Imperative

Along with the legal and regulatory imperatives, there is also a moral imperative to be considered. Governing boards of non-profit health care organizations hold the resources of their organization in trust for the community they serve and therefore are responsible for ensuring that their organization provides safe, effective, and appropriate care to all patients.  Boards can accomplish this by planning for the delivery of necessary services and providing the appropriate level of resources and support needed to fulfill its commitment to improved organizational performance. Leadership, through its behavior and expectations for action, can also foster a culture that promotes safety and quality and emphasizes open communication and transparency.

It’s been said that anything that has the potential to harm the organization or its clients should be a concern of the board. Thus, effective boards are staying informed and seeking continuous training on this important issue.


(Reference:  Schyve, Paul. Leadership in Healthcare Organizations. San Diego: The Governance Institute, Winter 2009. Print.)

Emerging Financial Imperative

As public and private payers increasingly link reimbursement to quality outcomes, the business case for quality oversight is no longer hypothetical. On the public side, the Centers for Medicare and Medicaid have implemented the value-based purchasing program attaching increasing amounts of reimbursement to clinical performance measures and rewarding high performing providers. Private insurers have also committed to moving away from fee-for-service payments and transitioning into value-based agreements. The movement to pay for performance rather than volume of services provided is intended to put financial pressure on healthcare providers to produce safe, efficient, high quality services.  Those organizations that do not perform well on quality measures will see reimbursement reduced.  With the growing concerns about the quality and cost of health care in this country, governing boards are being called upon to set the direction for their organizations and create an environment where clinicians, management, and the board work together to promotes behavioral change at the individual and organizational level.


(Reference: Transforming Care Delivery to Focus on Patient Outcomes: Why Boards Matter

Christine Izui AHA Center for Healthcare Governance 155 North Wacker Drive Suite 400 Chicago, Illinois, 2012)